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2540-PM-BWM0398 4/2006 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU OF WASTE MANAGEMENT Date Prepared/Revised DEP USE ONLY Date Received FORM M LAND APPLICATION This form must be fully and accurately completed. All required information must be typed or legibly printed in the spaces provided. If additional space is necessary, identify each attached sheet as Form M, reference the item number and identify the date prepared. The “date prepared/revised” on attached sheets should match the “date prepared/revised” on this page. General References: Chapter 291 SECTION A. SITE IDENTIFIER Applicant/permittee: Site Name: Facility ID (as issued by DEP): SECTION B. GENERAL INFORMATION 1. Identify the type of application proposal. Agricultural Utilization 2. Land Reclamation Identify the type of waste and origin. Residual waste Other(s) (Please specify) origin: a. b. c. d. Attach a completed Form U. SECTION C. SOIL INFORMATION 1. List each soil series present on site. Source Providing Information: a. b. c. d. e. 2. Attach pit or excavation descriptions written in the following format: Example: Pit # Pit #1 Pit #2 Depth 0" - 12” Color dark brown Texture sandy loam Structure granular Consistence friable none 12" - 24” yellowish brown silt loam subangular blocky firm none 24" - 40" brown loam prismatic hard grayish brown mottles 40” + bedrock etc. -1- Mottling 2540-PM-BWM0398 4/2006 SECTION C. SOIL INFORMATION (continued) 3. Has the site been used previously for waste application? 4. Soil chemical analysis information. A minimum of one background chemical analysis from soil in each soil series at the proposed facility is required. Attach copies of the original laboratory analysis reports and identify the methods of sampling and analysis. Identify the sampling areas on the Form 4R or Form 2 map requirement – Phase 1. Complete the following information: Yes No Accreditation Number of laboratory performing the analysis soil series pH The following on a dry weight basis. phosphorus, ppm cadmium, ppm zinc, ppm copper, ppm nickel, ppm lead, ppm chromium, ppm mercury, ppm other In addition, if waste was previously applied to the proposed permit area, include soil analyses from similar soils adjacent to the facility where waste has not been applied. soil series pH The following on a dry weight basis. phosphorus, ppm cadmium, ppm zinc, ppm copper, ppm nickel, ppm lead, ppm chromium, ppm mercury, ppm other 5. What is the maximum slope at the proposed site? 6. What is the shallowest depth from the surface to the seasonal high water table? A. 7. How was the above determined? What is the shallowest depth to the bedrock? A. 8. percent inches How was the above determined? What is the flooding frequency of the site? -2- inches 2540-PM-BWM0398 A. 4/2006 How was the above determined? SECTION D. SURFACE WATER INFORMATION 1. Identify the name of the watershed which will receive water discharges from the proposed permit area and adjacent area. 2. What are the uses of groundwater in the proposed permit area and adjacent area? 3. Provide a description of any known groundwater quality problems in the proposed permit area and adjacent area. SECTION E. SUPPLEMENTAL DATA 1. 2. A written operational narrative for all land application sites shall be attached to discuss the following: a. The operating plan for the site including site preparation, the proposed life of the operation, and the total weight or volume of waste that is proposed to be applied during the operation. b. The proposed application rate per acre and the dates when waste will be applied. c. A complete justification for the proposed loading rates, including an analysis of the effect of the proposed loading rates over the lifetime of the facility on air, soil, water, and other natural resources. d. The method by which waste will be applied and incorporated into the soil, and the party responsible for incorporation. e. The equipment to be used for site preparation, land application, waste incorporation, and seeding. f. The use of the proposed permit are after waste disposal has permanently ceased. g. The nuisance control plan to prevent health hazard or nuisances. h. The waste storage plan. i. The method by which the operator of waste application vehicle will determine the waste application rate during the operation. j. The permit area markers to be used. k. The waste analysis schedule. l. An analysis of the effect the proposed operation and loading rates over the lifetime of the facility on the air, water, vegetation, and other natural resources. m. For land reclamation attach copy of erosion and sedimentation control plan. Additionally, the operational narrative for agricultural utilization sites shall include the following: a. The projected use of the crops. b. A nutrient management plan for the site, including: 1) A description of the kind and amount of fertilizers or soil conditioners that will be placed on the site in addition to waste. 2) The number and kind of animals on the farm or property including the total nutrient value of manure produced by those animals and the location where such manure is placed. Complete Section F, Manure Management, on page 5 of this Form M. 3) An explanation and analysis of the effect on the soil of the additional nutrients that would be supplied by the waste. c. Attach a copy of the farm conservation plan. -3- 2540-PM-BWM0398 4/2006 SECTION F. MANURE MANAGEMENT The nutrient management plan for the site is to include a manure management plan for the farm or property. The following calculations shall be completed to identify the number and kind of animals on the farm or property, the total nutrient value of the manure produced by those animals and the location where such manure is placed. Calculation 1: amount of manure nutrients available 1. 2. Example for dairy cattle Your farm Animal Type Number of 1000-pound animal units: a. total wt: no. of animals x wt per animal b. animal units: total wt (Item 1a) 1000 lb. 50 x 1300 = 65,000 65 au Animal days of manure added to storage: a. full days confined b. partial days confined: 200 days hours continued 24 hours x no. of days c. 12 24 x 165 = 83 days equivalent days stored: no. of full days (Item 2a) + number of partial days (Item 2b) 3. 200 + 83 = 283 days Tons of manure produced during storage period: lb/day/animal unit (Table 4) x no. of animal units (Item 1b) X equivalent days stored (Item 2c) 2000 lb/ton 4. (82 x 65 x 283) 2000 = 754 tons Manure nutrients available: TOTAL tons of manure (Item 3) x total (754 x l0 x.5) N nutrients N, P2O5, K2O, (Table 4) or 3770 lbs. (754 x 4) P2O5 3016 lbs (754 x *) K2O 6032 lbs manure analysis, x (for nitrogen only) nitrogen availability (Table 5) Calculation 2: Crop nutrient requirements for farm (exclude the proposed or permitted site acreage). Crop 1. Acres Yield Per Acre Nutrient Crop Nutrient Requirements (Table 2) Requirement Per Acre (Table 2) (Acres X Nutrient Requirement Per Acre) N P2O5 K2O N 2. 3. TOTAL -4– P2O5 K2O